Cardiac allograft vasculopathy develops in a majority of transplanted hearts at a variable rate. In rare instance as early as 3
months after transplantation. According to the international society for heart and lung transplantation (ISHLT) only 47% of adults are free of CAV as detected by angiography at 9.5 years. In children, the incidence is lower compared with adults, with 75% of patients free of CAV at 7 years post transplant.

Allograft vasculopathy involves both epicardial and intramural coronary arteries. The classic feature of CAV is that of diffuse concentric narrowing with luminal stenosis. The images below show gross examination examples of allograft vasculopathy in a pediatric age heart. The epicardial coronaries are markedly thickened. Microscopic features of allograft vasculopathy are shown here.